Book ReviewsJeffrey A. Kelly (1995).Changing HIV Risk Behaviour. New York: Guildford Press (159 pp).

Jeffrey Kelly is the acknowledged expert and innovator inthe field of cognitive behavioural interventions aimed atreducing HIV risk behaviours and preventing infection.In an area too often characterized by enthusiasm withoutadequate theoretical underpinning or appropriate evalua-tion, the work of Kelly and his colleagues is an example ofthe rigorous, imaginative and sensitive application ofpsychological principles to a difficult and importantproblem. Beginning with risk reduction interventions forgay men in the 1980s, he and his group have extendedtheir work to other individuals including inner citywomen and psychiatrically ill adults.

This book is subtitled Practical Strategies and its eight-chapter format reflects the main components shared byeffective programmes. The first chapter covers the actionof HIV on the immune system, epidemiology and trans-mission. It includes a detailed description of behavioursconferring risk as well as identifying individuals atgreatest risk and the factors which contribute to thatvulnerability. Chapter 2 describes the conceptual frame-work of risk reduction interventions which requirethe development and use of cognitive, attitudinal andbehavioural skills. The third chapter suggests, with caseexamples, ways in which interventions can be integratedinto social, community or health care systems alreadyused by the populations to be targeted. This is importantsince those at risk do not often seek help. Procedures forassessment make up one of the longest chapters in thebook which is full of useful ideas from evaluation ofcondom skills to functional analysis of risk-relatedcircumstances and assessment of safer sex negotiationskills using role play.

The following three chapters describe the content ofintervention: HIV risk education and motivating people tochange, risk behaviour, self-management skills and sexualassertiveness training. Kelly has a background in socialskills training and has always emphasized its importancein enabling individuals to reduce their HIV risk, especiallyas few have effective safer sex communication skills or theability to resist coercive risk pressures. There are detaileddescriptions of procedures and suggestions for theiradaptation to specific circumstances as well as many caseexamples. Throughout the text, there is an emphasis onthe context in which individuals' risk behaviour takesplace whether in terms of social, cultural, relationship orpersonal factors and the final chapter addresses ways ofpromoting change in communities especially among thosewho are socially disadvantaged, stigmatized or both.

This book is intended to be a practical guide to imple-menting risk reduction and as such includes relativelylittle in the way of theory. Although reference is made tocognitive change methods for developing efficacy beliefsand countering negative attributions about condom use,these are perhaps somewhat limited given the develop-ment of cognitive therapy methods in use currently.Finally, readers should be aware that the book focuses onthe population in the USA although most of the contentwill also be relevant to European countries. A very usefulbook and, as the first in its field, sure to prove extremelyvaluable.

Susan ThorntonPsychological Medicine Unit,

Chelsea and Westminster Hospital,London, UK

# 1997 by John Wiley & Sons, Ltd.

Clinical Psychology and Psychotherapy, Vol. 4 (1), 72 (1997)